Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Pontine angle tumors such as vestibular neuromas and meningiomas frequently present. Outcomes after gamma knife radiosurgery in solitary acoustic tumors and neurofibromatosis type 2 authors. Pdf epidermoid tumors of the cerebellopontine angle. Methods a retrospective analysis of clinical notes identified 42 patients with nonacoustic tumours of the cerebellopontine.
Cerebellopontine angle primitive neuroectodermal tumor. Cushing 1917 was the first to advocate intracapsular tumor. Surgery of cerebellopontine lesions madjid samii springer. The differential diagnoses of the tumor in the cerebellopontine angle included trigeminal neurilemmoma and meningioma. Primitive neuroectodermal tumors pnets comprise a group of aggressive, poorly differentiated embryonal tumors occurring in central nervous system as well as in peripheral locations. Surgical outcomes of cerebellopontine angle tumors in 50 cases. Early complications and symptoms of cerebellopontine angle tumor surgery. Lesions of the cpa are frequent and represent 6%10% of all intracranial tumors.
Acoustic neuroma and other cerebellopontine angle tumors. Warning of a high probability of malignancy article pdf available in journal of neurooncology 1123 february 20 with 1,0 reads. Thus there may occur cysts, gliomas, ependymomas, aneurysms, osteomas, meningiomas, and cholesteatomas. The symptoms and signs of cpa disease are nonspecific, relating either to compression of the neural structures found within it or from compression. Clinical features and outcomes in patients with non. Abstractobjectiveto report experiences with use of otoendoscopy in cerebellopontine angle cpasurgeries. Cerebellopontine angle meningioma diagnosed based on. Tumor cerebellopontine angle wahyuliati mutiara medika. Neoplasms in the cerebellopontine angle cpa account for only 1% of the pediatric central nervous system tumors. The cerebellopontine angle cpa is a common location for intracranial tumors but is a rare site for tumor metastasis.
Bruns nystagmus in cerebellopontine angle tumor neuro. History of cerebellopontine angle surgery 1st successful complete removal. An acoustic neuroma is a benign tumour that develops in the acoustic or auditory nerve. The retrosigmoid endoscopic approach for cerebellopontine angle tumors and microvascular decompression. This paper demonstrates a unique case in which a cpa lipoma was. They constitute the most frequently diagnosed tumors of the posterior fossa and account for up to 10% of all intracranial neoplasms. Tumors of the cp angle account for 5% to 10% of all intracranial neoplasms. There is a wide variety of conditions that can occur at this level, derived from both the structures forming the cerebellopontine angle, as lesions that grow near it and can secondarily invade.
Cerebellopontine angle cpa meningiomas account for 1. Ppt cerebellopontine angle masses powerpoint presentation free to download id. Retrosigmoid approach for resection of an extraventricular choroid plexus papilloma in the cerebellopontine angle. Ebook download surgery of the cerebellopontine angle, by nicholas c. Cerebellopontine angle tumor neoplasm of cerebellopontine angle. In view of the clinical findings, a diagnosis of a spaceoccupying lesion involving the left cerebellopontine angle was considered.
Tumors of the cerebellopontine angle request pdf researchgate. Imaging of the cerebellopontine angle practical neurology. Cerebellopontine angle masses can be divided into four groups, based on imaging characteristics. Cerebellopontine angle paraganglioma report of a case. The cerebellopontine angle cistern is a cerebrospinal fluidfilled space bound by the pons, cerebellum, and petrous temporal bone.
Surgery of the cerebellopontine angle 1st edition pdf download now surgery of the cerebellopontine angle is a single volume text which meshes the information available in surgical atlases with clinical disease entities. This is a prospective study of 30 patients at the neurosurgical department medical city, with mean age of 36 years with cpa tumors predominantly acoustic neuroma that underwent surgical removal using a suboccipital retrosigmoid approach over a 1year. Microanatomical variations in the cerebellopontine angle associated with vestibular schwannomas acoustic neuromas. Of the nonacoustic tumors, the majority were meningiomas, primary cholesteatomas, and neurinomas of other cranial nerves in the posterior fossa. Patients with cerebellopontine angle tumors, including acoustic neuromas, usually have a. Tumors of the cerebellopontine angle cpa constitute about 610% of all intracranial tumor, it is a disease common in adults and rarely in children. Calcifying pseudoneoplasms of the neuraxis are rare tumors. Emphasizes the need for an individualized approach tailored to the tumor variant. A comprehensive guide to the diagnosis and treatment of cerebellopontine angle tumors with the principal focus on surgical management.
It is important to have knowledge of this pathology and to be able to differentiate it from other commonly occurring cpa tumors. The pathology of the cpa can arise from the different structures in its anatomy and vecinity, like the cisterns, arteries. Although several mechanisms for cranial nerve dysfunction due to these tumors have been proposed, no direct evaluation for hyper or hypoactive dysfunction has been done. Cerebellopontine angle syndrome is usually due to an acoustic schwannoma arising from the vestibular nerve. These features were studied in patients presenting to the regional neurootological unit. Pdf cerebellopontine angle cpa tumors are uncommon in children, and the pathological spectrum is different from that of adults. The inclusion of an interactive atlas adds to the importance of the text and complements it, and also obviates the need to. Studies reveal that acoustic neuromas vestibular schwannomas constitute nearly 80% of all cerebellopontine angle tumors.
Synchronous tumors of the cerebellopontine angle mayo clinic. Focal hyperintensity fhi in the dorsal brain stem on t2weighted images of patients with cerebellopontine angle cpa tumor was thought to indicate degeneration of. Pediatric cerebellopontine angle and internal auditory canal tumors. Clinical examination revealed gross papilledema in both eyes with secondary optic atrophy. To report our experience with a large series of surgical procedures for removal of cerebellopontine angle cpa tumors using different approaches. Epidermoid cysts constitute less than 1 % of intracranial tumors with the majority of them involving cerebellopontine angle cpa. This was a retrospective analysis of 50 patients mean age, 49 years with cpa tumors predominantly acoustic neuroma who underwent surgical removal. Cerebellopontine angle cpa tumors are masses located in the region between the cerebellum and pons.
She had features of increased intracranial pressure. Cerebellopontine angle tumor in a patient with a maternally inherited sdhd gene mutation larry d. Cerebellopontine angle tumor neoplasm of cerebellopontine. Masses in this region are readily identified on crosssectional im. Objectives nonacoustic tumours of the cerebellopontine angle differ from vestibular schwannomas in their prevalence, clinical features, operative management, and surgical outcome. Focal hyperintensity in the dorsal brain stem of patients. Logan turners diseases of the nose throat and ear pdf. Rare tumors of the cerebellopontine angle derald e.
Radiologically indistinguishable contiguous meningioma and. Cushing 1917 was the first to advocate intracapsular tumor removal and hence recurrence. Patients with cerebellopontine angle tumors, including acoustic neuromas, usually have a unilaterally reduced vestibular response on caloric testing on the side of the lesion. An endoscopic assisted retrosigmoid approach to the. Pdf tumors in the cerebellopontine angle in children. Schwannoma of right cerebellopontine angle is extremely rare to diagnose by cytology. Temporal resolution in patients with cerebellopontine angle tumors deficits have not been adequately explored and an attempt to understand this aspect is the high light of the current study. Chapter 38 cerebellopontine angle tumors madjid samii, venelin m. Majority of the cerebellopontine angle cpa tumors are acoustic neuromas, while bulk of the nonacoustic tumors are formed by meningiomas and epidermoid cysts. Much rarer primary tumors are schwannomas of other cranial nerves.
Cureus surgical management and outcome experience of 53. Cerebellopontine angle cpa masses are relatively common. Primary extraosseous ewing sarcoma in the cerebellopontine. Temporal resolution in patients with cerebellopontine. P y gao, a g osborn, j g smirniotopoulos, c p harris. A 47yearold female was diagnosed by mri with a tumor of right cerebellopontine angle cytologic material from the tumor was. Gerganov clinical pearls comprehensive knowledge of the complex anatomy of the cerebellopontine cp angle is a prerequisite for achieving good surgical results. In this case series, pathophysiology of cranial nerve dysfunction in cpa epidermoid cysts was. The angle is bordered laterally and anteriorly by the posterior face of the petrous temporal bone. Epidermoid tumors caused various symptoms, especially in the cerebellopontine angle 15 cases, of which a transient. The cpa is defined as the angle formed in the horizontal section by the pons and the cerebellum in which the trigeminal v and acousticofacial nerve bundle viii are located. Recently, a case has been described wherein a paraganglioma was apparently arising as a primary. Although a diverse range of pathologies may be seen in this region, the most common by far is a vestibular schwannoma pathology.
Pdf nonacoustic tumors of the cerebellopontine angle. The tumor was approached via a right posterior fossa craniectomy and removed with the finger. Disease involving the cerebellopontine angle cpa may arise from structures located within the cistern or from extension of lesions located primarily outside the cisternfrom the brainstem, fourth ventricle, choroid plexus and bony skull base. Many different types of tumor may arise in the cerebellopontine angle. Methodstwenty five cases of cpa surgeries performed between november 2002 and december 2008 in which mi. Cerebellopontine angle tumors otolaryngologists perspective.
Gamma knife radiosurgery for cerebellopontine angle epidermoid tumors has rarely been reported. Together these masses account for 85%90% of all cpa tumors. Both lipomas and dermoid cysts of the cerebellopontine angle are rare tumors. The adobe flash plugin is needed to view this content. Primary cerebellopontine angle cpa pnet is an extremely rare entity. As the tumor was symptomatic, we discussed the potential treatment options with the patient, who decided to undergo gamma knife treatment at her local hospital. Gamma knife radiosurgery for cerebellopontine angle. Tumors of the cerebellopontine angle jama otolaryngology. Superior anatomical view of the left cerebellopontine angle cpa.
Other tumors presenting in this area are meningioma, epidermoid, pontine glioma, and cerebellar astrocytoma. In a series of 1,354 cerebellopontine angle tumors treated at the otologic medical croup, approximately 10% were lesions other than acoustic neurinomas. Van hemert, 3 and john dornhoffer 1 1 department of otolaryngologyhead and neck surgery, 2 division of genetics, department of family medicine, winthrop p. We report one such rare case presenting the cytological features in material obtained during the resection of the tumor. Cerebellopontine angle mass radiology reference article. Schwannomas are the most common tumors in the cerebellopontine cp angle. They are benign tumors commonly seen in adults, which usually present after a long asymptomatic period. Calcifying pseudoneoplasm of the cerebellopontine angle. Lesions in this region are readily identified on crosssectional images. Primary paraganglioma is a rare tumor in this location, with only two such cases having been reported in the literature, till date. This group of tumors account for nearly 10% of all intracranial tumors.
The cerebeliopontine angle cpa cistern is a cerebrospinal fluidfilled space bound by the pons, cerebellum, and petrous temporal bone. To our knowledge, the current study is the largest case series to report on radiosurgery for cerebellopontine angle epidermoid tumors. The crucial neurovascular structures should be identified as early as possible during surgery, which enables their preservation and guides subsequent operative steps. Renal cell carcinoma metastasis to the cerebellopontine.
Cerebellopontine angle an overview sciencedirect topics. The characteristic morphological features of these depend on the tissue from which the tumors arise. Pdf early complications and symptoms of cerebellopontine. A 35yearold woman presented with insidious onset of hearing loss on the left side along with progressive unsteadiness of gait and diminution of vision. Well, still perplexed of ways to obtain this ebook surgery of the cerebellopontine angle, by nicholas c. For about 85% of tumors in the region of the cerebellopontine angle is acoustic neuroma, 10% are meningiomas and 5% are epidermoid tumor. These tumors differ in their embryological origin but share similar features on imaging. Nearly 90% of all cpa tumors include vestibular schwannomas acoustic neuromas and meningiomas.
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